Response to Letter Regarding Article, “Achievement of Dual Low-Density Lipoprotein Cholesterol and High-Sensitivity C-Reactive Protein Targets More Frequent With the Addition of Ezetimibe to Simvastatin and Associated With Better Outcomes in IMPROVE-IT”

In response to Dr Robinson, we have made clear throughout our article that the data presented are observational and therefore support the idea that low low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein levels are associated with low rates of cardiovascular events.1 Given the observational nature of the present analysis, limitations exist, which have been acknowledged in our article and in the editorial.With regard to our observation that lower on-treatment high-sensitivity C-reactive protein levels are associated with lower residual risk, we note that the data from IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) are directionally consistent with prior data from the Cholesterol and Recurrent Events (CARE), Air Force Coronary Arteriosclerosis Prevention Study (AFCAPS)/Texas Coronary Atherosclerosis Prevention Study (TexCAPS), Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT-TIMI 22), Aggrastat-to-Zocor (A-to-Z), and Justification for the Use of Statins in the Prevention: an Intervention Trial Evaluating Rosuvastatin …